A Case for Care Management

In keeping with the season, here is a real-life, horror story, and some ideas on how to avoid this happening to the one you are caring for. Happy Halloween…

A care facility in Castro Valley, California recently had its Residential Care Facility for the Elderly (RCFE) license revoked; the horror begins when the county and facility owners bungled the relocation of 14 of its 33 residents, and the community failed to provide adequate care in the interim. When the overwhelmed and unpaid community staff called 911 late one night, the remaining residents were all transported to other hospitals and communities.  Many of resident families did not know about the closure until they arrived for a weekend visit. What is so chilling about this story, is that placing a loved one in a care facility is such a difficult venture to begin with, and for the chosen community to fall so short without required warning is very frightening.

A call to San Francisco’s local California Community Care Licensing Department (CCLD), revealed that it is only able to inspect senior care facilities once every five years at this time – the intended goal being a yearly inspection for every community. While they are approaching full staff again (after a major reduction due to the economic downturn several years ago) they expect to be back on track with yearly inspections soon.

Inspections by the CCLD do not include ratings, rather they simply check to see that communities are in compliance with Title 22 requirements. If communities are not in compliance, they are sited, and expected to correct violations within one day to one week (depending on the severity of the violation), or else their licensing is revoked.  The agency keeps a “facility file” on each community which contains agency substantiated complaints, and violations found during inspections. The file does not contain lawsuits filed against a community, one must go to the county court for those public records.Reviewing a facility’s CCLD facility file can be revealing, however, substantiated complaints can probably be found in every care community’s file. The number of complaints and violations may be more telling than the presences of complaints.  One assisted living Executive Director reports that in seven years he has only seen about four complaints against the communities he has been involved with. He confirmed that, “one or two complaints a year is common, but five or six may be a sign of trouble,” – a CCLD staff member unofficially confirmed this as well.

To access the facility files, contact the CCLD with a list of facility for review. The files are not available online because CCLD staff must review the file and remove any confidential information about identifiable residents before making them available for public review.

The best way to assess a community is still by word of mouth, or by working with a Care Manager (especially one who does not accept referral incentives from the communities).  A Care Manager can report on their own experience with a community; more accurately match a client in need of placement with the best community; and guide the client and family through  an often stressful transition. One can and should also, do their own research – visit communities, meet with management and staff, check the activity roster, etc..

Note for the writer:

I do not like ending this entry with what sounds like a hard sell, however, this horror scenario is a perfect reason for engaging with a Care Manager, like myself. The time savings and a greater piece of mind is priceless. Getting help with difficult decisions, and transitions like a move into an assisted living community takes the burden off of many overburdened family/community care givers. It is also something that comes up constantly in informational, and peer groups that I moderate.

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5 thoughts on “A Case for Care Management

  1. It’s good to have you on the seniors side. I laughed at the cartoon about no one wanting to talk about final arrangements. I’m the same way. I think if I would go ahead and do it I wouldn’t have to think about it every day for the rest of my life..lol

    1. I think you are talking about the repost of Roz Chast’s graphic novel. She really does hit many of the hot topics involving making end of life decisions, and how those decisions change over time, and in the face of cognitive decline.

      It may be a “comic” but it is a very poignant set of topics presented in a very honest way.

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